河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (1): 55-59.doi: 10.3969/j.issn.1007-3205.2025.01.010

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儿童阻塞性睡眠呼吸暂停综合征的早期诊断、个体化治疗及随访研究

  

  1. 1.内蒙古自治区鄂尔多斯市中心医院儿科,内蒙古 鄂尔多斯 017000;2.内蒙古自治区
    鄂尔多斯市中心医院耳鼻喉科，内蒙古 鄂尔多斯 017000

  • 出版日期:2025-01-25 发布日期:2025-01-22
  • 作者简介:张巧丽（1985-），女，内蒙古鄂尔多斯人，内蒙古自治区鄂尔多斯市中心医院副主任医师，医学硕士，从事儿科疾病诊治研究。
  • 基金资助:
    内蒙古自治区卫生健康科技计划项目（202201588）

Early diagnosis, individualized treatment and follow-up study of obstructive sleep apnea syndrome in children

  1. 1.Department of Pediatrics, Ordos Central Hospital, Inner Mongolia Autonomous Region, 
    Ordos 017000, China; 2.Department of Otolaryngology, Ordos Central Hospital, 
    Inner Mongolia Autonomous Region, Ordos 017000, China
  • Online:2025-01-25 Published:2025-01-22

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摘要： 目的  研究儿童阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）的早期诊断、个体化治疗及随访结果。
方法 选取5~10岁OSAS患儿120例作为观察对象，统计患儿一般资料；结合患儿临床特征，经鼻咽侧位X线摄片、纤维鼻咽镜及多导睡眠监测（polysomnography，PSG）检查，总结其诊断、治疗过程及随访结果。
结果  OSAS患儿主要临床特征为睡眠打鼾（120例，100.00%）、睡眠憋气（89例，74.17%）、张口呼吸（107例，89.17%）、听力降低（14例，11.67%）、遗尿（10例，8.33%）。120例患儿中87例（72.50%）伴有扁桃体肥大，88例（73.33%）伴有腺样体肥大，15例（12.50%）伴有扁桃体肥大和腺样体肥大。轻度OSAS11例（9.17%），中度OSAS59例（49.17%），重度OSAS50例（41.67%）。针对轻度和中度OSAS患儿（不伴有腺样体和扁桃体肥大），结合家长意愿，16例给予鼻用糖皮质激素和（或）孟鲁司特钠治疗，10例（62.50%）患儿治愈或明显好转；45例接受扁桃体切除，44例（97.78%）患儿治愈或明显好转；42例接受腺样体切除，40例（95.24%）患儿治愈或明显好转；15例接受扁桃体+腺样体切除，14例（93.33%）患儿治愈或明显好转。治疗后3个月、6个月，OSAS患儿阻塞性呼吸暂停指数、睡眠呼吸暂停低通气指数低于治疗前，最低动脉血氧饱和度高于治疗前（P＜0.05）。
结论 OSAS患儿临床表现明显、伴发疾病较多，可结合鼻咽侧位X线摄片、PSG、纤维鼻咽镜检查综合考虑进行诊断，针对患儿具体病情制定个性化治疗，其中扁桃体、腺样体切除是治疗OSAS的有效治疗手段。


关键词: 睡眠呼吸暂停, 阻塞性, 早期诊断, 治疗, 儿童

Abstract: Objective To study the early diagnosis, individualized treatment and follow-up results of obstructive sleep apnea syndrome (OSAS) in children. 
Methods A total of 120 children with OSAS aged 5-10 years were selected as the observation subjects. General information of children was collected. Based on the clinical characteristics of the children, the diagnosis, treatment process, and follow-up results were summarized through nasopharyngeal lateral X-ray, fiberoptic nasopharyngoscopy, and polysomnography (PSG) examination. 
Results The main clinical characteristics of children with OSAS were sleep snoring (n=120, 100.00%), sleep apnea (n=89, 74.17%), mouth breathing (n=107, 89.17%), hearing loss (n=14, 11.67%), and enuresis (n=10, 8.33%). Of the 120 children, 87 (72.50%) had tonsillar hypertrophy, 88 (73.33%) had adenoidal hypertrophy, and 15 (12.50%) had both tonsillar and adenoidal hypertrophy. There were 11 cases (9.17%) of mild OSAS, 59 cases (49.17%) of moderate OSAS, and 50 cases (41.67%) of severe OSAS. For mild and moderate OSAS children (without adenoid and tonsillar hypertrophy), combined with the parents′ wishes, 16 patients were treated with nasal glucocorticoids and/or montelukast sodium, and 10 patients (62.50%) were cured or significantly improved. In addition, 45 patients underwent tonsillectomy, and 44 patients (97.78%) were cured or significantly improved; 42 patients underwent adenoidectomy, and 40 patients (95.24%) were cured or significantly improved. Another 15 patients underwent tonsillectomy and adenoidectomy, and 14 patients (93.33%) were cured or significantly improved. At 3 and 6 months after treatment, the obstructive apnea index and sleep apnea hypopnea index in children with OSAS were lower than those before treatment, and the lowest arterial oxygen saturation was higher than that before treatment (P＜0.05). 
Conclusion Children with OSAS have obvious clinical manifestations and more accompanying diseases. The diagnosis can be combined with lateral nasopharyngeal X-ray, PSG and fibrous nasopharyngoscopy, and individualized treatment can be developed according to the specific conditions of children. Among them, tonsillectomy and adenoidectomy are effective treatment methods for OSAS. 


Key words: sleep apnea, obstructive, early diagnosis, treatment, child

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